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Salisbury AC, Safley DM, Kennedy KF, Bhardwaj B, Aronow HD, Jones WS, Feldman DN, Secemsky E, Tsai TT, Attaran RR, Spertus JA. Development and validation of a predictive model for bleeding after peripheral vascular intervention: A report from the National Cardiovascular Data Registry Peripheral Vascular Interventions Registry. Catheter Cardiovasc Interv 2021; 98:1363-1372. [PMID: 34569709 DOI: 10.1002/ccd.29961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/08/2021] [Accepted: 09/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To develop a model to predict risk of in-hospital bleeding following endovascular peripheral vascular intervention. BACKGROUND Peri-procedural bleeding is a common, potentially preventable complication of catheter-based peripheral vascular procedures and is associated with increased mortality. We used the National Cardiovascular Data Registry (NCDR) Peripheral Vascular Interventions (PVI) Registry to develop a novel risk-prediction model to identify patients who may derive the greatest benefit from application of strategies to prevent bleeding. METHODS We examined all patients undergoing lower extremity PVI at 76 NCDR PVI hospitals from 2014 to 2017. Patients with acute limb ischemia (n = 1600) were excluded. Major bleeding was defined as overt bleeding with a hemoglobin (Hb) drop of ≥ 3 g/dl, any Hb decline of ≥ 4 g/dl, or a blood transfusion in patients with pre-procedure Hb ≥ 8 g/dl. Hierarchical multivariable logistic regression was used to develop a risk model to predict major bleeding. Model validation was performed using 1000 bootstrapped replicates of the population after sampling with replacement. RESULTS Among 25,382 eligible patients, 1017 (4.0%) developed major bleeding. Predictors of bleeding included age, female sex, critical limb ischemia, non-femoral access, prior heart failure, and pre-procedure hemoglobin. The model demonstrated good discrimination (optimism corrected c-statistic = 0.67), calibration (corrected slope = 0.98, intercept of -0.04) and range of predicted risk (1%-18%). CONCLUSIONS Post-procedural PVI bleeding risk can be predicted based upon pre- and peri-procedural patient characteristics. Further studies are needed to determine whether this model can be utilized to improve procedural safety through developing and targeting bleeding avoidance strategies.
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Affiliation(s)
- Adam C Salisbury
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA
| | - David M Safley
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA
| | - Kevin F Kennedy
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA
| | | | - Herbert D Aronow
- Lifespan Cardiovascular Institute, Brown University, Providence, Rhode, USA
| | - William Schuyler Jones
- Division of Cardiology, Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - Dmitriy N Feldman
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Eric Secemsky
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thomas T Tsai
- University of Colorado Institute for Health Research and Kaiser Permanente, Denver, Colorado, USA
| | | | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA
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Roghani-Dehkordi F, Zangeneh E, Kermani-Alghoraishi M. Manual versus mechanical compression hemostasis approach after coronary angiography via snuffbox access. Anatol J Cardiol 2021; 25:177-183. [PMID: 33690132 PMCID: PMC8114725 DOI: 10.14744/anatoljcardiol.2020.99672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 10/01/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Distal radial artery access or trans-snuffbox access (TSA) is a novel, safe, and feasible technique for coronary artery interventions wherein its vascular hemostasis is still concerned. So, this study aimed to compare two homeostasis methods comprising manual and mechanical compression approaches in patients undergoing coronary angiography (CAG) via TSA. METHODS In a prospective nonrandomized clinical trial, a total of 80 patients undergoing diagnostic CAG by TSA were divided into two equal groups: manual compression and mechanical compression (using radial TR band), the main end point of which was primary hemostasis time. Other variables were patient satisfaction, puncture site pain severity, hospitalization time, and local neurovascular complication during the 30-day follow-up. RESULTS The mean age of the patients was 57.1±8.0 years, with 40 of them (54.1%) being male. The primary hemostasis time was significantly shorter in the manual compression approach [15.0±5.9 minutes with median 15 (9-20)] than in the TR band group [25.7±4.9 minutes with median 25 (20-30)] (p<0.001). No significant difference was noted in the patient's satisfaction and puncture site pain severity as well as hospitalization time between the two methods (p>0.050). The neurovascular complication, including hematoma, numbness, and dRA occlusion, rates had also no significant difference between the two groups (p>0.050). CONCLUSION The manual compression approach on the puncture site reduces hemostasis time in patients undergoing CAG via TSA when compared with the mechanical compression method.
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Affiliation(s)
- Farshad Roghani-Dehkordi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences; Isfahan-Iran
- Department of Cardiology, Faculty of Medicine, Isfahan University of Medical Sciences; Isfahan-Iran
| | - Elham Zangeneh
- Department of Cardiology, Faculty of Medicine, Isfahan University of Medical Sciences; Isfahan-Iran
| | - Mohammad Kermani-Alghoraishi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences; Isfahan-Iran
- Department of Cardiology, Faculty of Medicine, Isfahan University of Medical Sciences; Isfahan-Iran
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Ocsan RJ, Doost A, Marley P, Farshid A. The Rise of Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndromes in Australia. J Interv Cardiol 2020; 2020:4397697. [PMID: 33312077 PMCID: PMC7719530 DOI: 10.1155/2020/4397697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) via transradial artery access (TRA) or transfemoral artery access (TFA). BACKGROUND Over the last decade, evidence for the benefit of TRA for PCI has grown, leading to a steady uptake of TRA around the world. Despite this, the topic remains controversial with contrary evidence to suggest no significant benefit over TFA. METHODS A retrospective study of consecutive ACS patients from 2011 to 2017 who underwent PCI via TRA or TFA. The primary outcome was Major Adverse Cardiovascular Events (MACE), a composite of death, myocardial infarction (MI), target lesion revascularisation (TLR), or coronary artery bypass graft surgery (CABG) at 12 months. Secondary outcomes included Bleeding Academic Research Consortium (BARC) bleeding events scored 2 or higher, haematoma formation, and stent thrombosis, in addition to all individual components of MACE. RESULTS We treated 3624 patients (77% male), with PCI via TFA (n = 2391) or TRA (n = 1233). Transradial artery access was associated with a reduction in mortality (3% vs 6.3%; p < 0.0001), MI (1.8% vs 3.9%; p=0.0004), CABG (0.6% vs 1.5%; p=0.0205), TLR (1% vs 2.9%; p < 0.0001), large haematoma (0.4% vs 1.8%; p=0.0003), BARC 2 (0.2% vs 1.1%; p=0.0029), and BARC 3 events (0.4% vs 1.0%; p=0.0426). On multivariate Cox regression analysis, TFA, age ≥ 75, prior PCI, use of bare metal stents, cardiogenic shock, cardiac arrest, and multivessel coronary artery disease were associated with an increased risk of MACE. CONCLUSION Despite the limitations secondary to the observational nature of our study and multiple confounders, our results are in line with results of major trials and, as such, we feel that our results support the use of TRA as the preferred access site in patients undergoing PCI for ACS to improve patient outcomes.
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Affiliation(s)
- Ryan James Ocsan
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Ata Doost
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Paul Marley
- Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia
| | - Ahmad Farshid
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia
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Birgy C, Trimaille A, Messas N, Ristorto J, Kayali A, Marchandot B, Cardi T, Hess S, Kibler M, Jesel L, Ohlmann P, Morel O. Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography. J Clin Med 2020; 9:jcm9092747. [PMID: 32854384 PMCID: PMC7564999 DOI: 10.3390/jcm9092747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
With respect to the transfemoral approach, transradial procedures enable a drastic reduction of bleeding events and are associated with a reduction of mortality. Radial artery spasm (RAS) is one of the most common complications and may lead to patient discomfort and procedural failure. Currently, there is no consensus on the optimal sedation protocol to avoid RAS. The aim of this study was to investigate the respective impact of opioids analgesia and inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox) on pain and occurrence of RAS during transradial coronary procedures. Consecutive patients undergoing transradial coronary angiography were prospectively enrolled in one, single center observational study (Nouvel Hôpital Civil, Strasbourg, France). Patients received opioids analgesia or inhalation sedation with Kalinox. The primary endpoints of the study were the incidence of a pain scale ≥5/10 and the occurrence of RAS. The secondary endpoints were the incidence of side effects. A total of 325 patients were enrolled (185 in the opioids analgesia group, 140 in the Kalinox group). RAS and pain scale ≥5 rates were not significantly different in the opioids analgesia and Kalinox groups (respectively 13.5% vs. 10.0% and 16.2% vs. 11.4%). Headache was more frequently observed in the Kalinox group (6.4% vs. 0.0%; p = 0.002). By multivariate analysis, female gender, BMI <25 kg/m2, puncture difficulty, the use of plastic needle and 6F sheath were identified as independent predictors of RAS. Procedural inhalation sedation by Kalinox is as safe as opioids analgesia during transradial coronary angiography.
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Affiliation(s)
- Caroline Birgy
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Antonin Trimaille
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
- INSERM UMR-1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France
| | - Nathan Messas
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Jessica Ristorto
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Anas Kayali
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Benjamin Marchandot
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Thomas Cardi
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Sébastien Hess
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Marion Kibler
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Laurence Jesel
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
- INSERM UMR-1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France
| | - Patrick Ohlmann
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
| | - Olivier Morel
- Pôle d’Activité Médico-Chirurgicale Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France; (C.B.); (A.T.); (N.M.); (J.R.); (A.K.); (B.M.); (T.C.); (S.H.); (M.K.); (L.J.); (P.O.)
- INSERM UMR-1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France
- Correspondence: ; Tel.: +33-369-551-736
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Clinical Outcomes of Bivalirudin Versus Heparin in Elderly Patients Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Cardiovasc Drugs Ther 2020; 34:101-111. [PMID: 32100149 DOI: 10.1007/s10557-020-06937-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to explore the safety and efficacy of bivalirudin in elderly patients undergoing percutaneous coronary intervention (PCI). METHODS An electronic search was conducted for randomized controlled trials with outcomes of interest in the elderly (≥ 65 years of age). Pooled risk ratios (RR) and 95% confidence interval (CI) using random effects Der Simonian-Laird models were calculated. Primary outcomes were net adverse clinical events (NACE) and major bleeding events at 30 days. Secondary outcomes were major adverse cardiac events (MACE) at 30 days. MACE, all-cause mortality, and NACE at 6-12 months were also examined. RESULTS Eleven trials that randomized a total of 15,895 elderly patients undergoing PCI to bivalirudin versus heparin were included. At 30 days, bivalirudin was associated with a reduced risk of NACE (0.86 [0.75-0.99], p = 0.04), mainly driven by reduction in major bleeding events (0.66 [0.54-0.80], p < 0.0001), as compared with heparin. On subgroup analyses based on the use of GPI in the heparin arm, benefit of major bleeding associated with bivalirudin appeared to be equally evident when GPI was used as a bailout (0.66 [0.46-0.94], p = 0.02) versus routine (0.67 [0.51-0.88], p = 0.004) adjunctive therapy with heparin. Subgroup analyses stratified by clinical presentation showed that benefit of bivalirudin in reducing NACE was even more obvious in the elderly group presenting with ST segment elevation myocardial infarction (STEMI) (0.76 [0.65-0.89], p = 0.0007), as compared with the overall (acute coronary syndrome or stable ischemic heart disease) group. No difference in MACE (0.94 [0.82-1.09], p = 0.42) was demonstrated between the two groups. Bivalirudin was associated with a similar risk of NACE (0.74 [0.39-1.42], p = 0.36) at 6 months and MACE (0.90 [0.68-1.19], p = 0.45) at 6-12 months, while a non-statistically significant trend toward lower all-cause mortality (0.70 [0.47-1.06], p = 0.09) at 1 year. CONCLUSION In elderly patients undergoing PCI, bivalirudin was associated with a lower risk of major bleeding events and the magnitude of benefit was not related to the use of GPI and irrespective of clinical presentation. Bivalirudin may reduce the NACE, particularly in elderly patients presenting with STEMI or in the setting of routine GPI use in the heparin arm, while no difference in MACE was demonstrated between the two groups.
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Akl E, Rashid MK, Alshatti A, Jolly SS. Transradial Angiography and Intervention in Acute Coronary Syndromes. Interv Cardiol Clin 2020; 9:33-40. [PMID: 31733739 DOI: 10.1016/j.iccl.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Considerable evidence supports transradial angiography and intervention in patients with acute coronary syndrome, with an emphasis on decreasing major bleeding and access site vascular complications. Patients undergoing invasive treatment are at greatest risk of bleeding and have the most to gain. The radial advantage has consistently been shown to translate into reduced mortality in pooled data analyses. The benefits of transradial access have been demonstrated across the acute coronary syndrome spectrum and in both sexes. A radial-first strategy should be the default approach and continuous efforts should be made to increase operator expertise of transradial access in these patients.
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Affiliation(s)
- Elie Akl
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mohammed K Rashid
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Ahmad Alshatti
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Juergens C. Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial. EUROINTERVENTION 2019; 15:e522-e530. [PMID: 31113763 DOI: 10.4244/eij-d-19-00336] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. METHODS AND RESULTS This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Transradial access reduced the primary outcome (RR 0.37, 95% CI: 0.17-0.81; p=0.013), mostly driven by ACUITY major bleeding (RR 0.343, 95% CI: 0.123-0.959; p=0.041) when compared with the transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance (p=0.76). Ultrasound guidance, however, reduced mean access time (93 sec vs. 111 sec; p=0.009), attempts (1.47 vs. 1.9; p<0.0001), difficult accesses (4.5% vs. 9.2%; p=0.0007), venepuncture (4.1% vs. 9.2%; p<0.0001) and improved first-pass success (73% vs. 59.7%; p<0.0001). CONCLUSIONS Transradial access significantly reduced the composite outcome compared to transfemoral access. Ultrasound guidance did not reduce the primary outcome compared to the standard technique, but significantly improved the efficiency and overall success rate of arterial access.
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Affiliation(s)
- Phong Nguyen
- Campbelltown Hospital, Campbelltown, NSW, Australia
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Naito T, Sawaoka T, Sasaki K, Iida K, Sakuraba S, Yokohama K, Sato H, Soma M, Okamura E, Harada T, Yoshimachi F. Evaluation of the diameter of the distal radial artery at the anatomical snuff box using ultrasound in Japanese patients. Cardiovasc Interv Ther 2019; 34:312-316. [PMID: 30617776 DOI: 10.1007/s12928-018-00567-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/31/2018] [Indexed: 01/01/2023]
Abstract
Catheter angioplasty or angiography via the distal access point of the radial artery (dRA), located at the anatomical snuff box, is a less invasive strategy for coronary intervention attracting considerable attention. Determining the diameter of the dRA is necessary to minimize the risk of artery occlusion and safely perform catheter intervention. This was a retrospective observational study including patients who underwent coronary angiography or coronary intervention at Aomori Kyoritsu Hospital, Aomori, Japan, between February 2018 and August 2018. The diameter of the dRA and the conventional access point of the radial artery (cRA) at the wrist of the patients were measured using ultrasound prior to angiography or interventional procedure. A total of 120 patients were analyzed. In male patients, the diameters of the cRA and dRA were 2.62 ± 0.60 mm and 2.04 ± 0.43 mm, respectively. In females, these diameters were 2.44 ± 0.51 mm and 1.96 ± 0.44 mm, respectively. Overall, the dRA was statistically significantly smaller than the cRA. However, variations were observed, with eight patients (6.7%) having a larger dRA than cRA. The diameter of the dRA indicated only that of the cRA. A multivariate analysis did not reveal factors associated with vessel diameter. The size and anatomy of the dRA varied considerably. Thus, it is difficult to predict the actual diameter of the artery. Customized selection of the size of the sheath and site of intervention is essential for each patient to safely perform ultrasound examination prior to cannulation.
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Affiliation(s)
- Takayuki Naito
- Department of Cardiology and Internal Medicine, Aomori Kyoritsu Hospital, 2-1-10 Higashi-Ohno, Aomori, 030-0847, Aomori, Japan.
| | - Takayuki Sawaoka
- Department of Cardiology and Internal Medicine, Aomori Kyoritsu Hospital, 2-1-10 Higashi-Ohno, Aomori, 030-0847, Aomori, Japan
| | - Kota Sasaki
- Department of Cardiology and Internal Medicine, Aomori Kyoritsu Hospital, 2-1-10 Higashi-Ohno, Aomori, 030-0847, Aomori, Japan
| | - Kazutaka Iida
- Department of Cardiology and Internal Medicine, Aomori Kyoritsu Hospital, 2-1-10 Higashi-Ohno, Aomori, 030-0847, Aomori, Japan
| | - Sachiko Sakuraba
- Department of Clinical Laboratories, Aomori Kyoritsu Hospital, Aomori, Japan
| | - Keiko Yokohama
- Department of Clinical Laboratories, Aomori Kyoritsu Hospital, Aomori, Japan
| | - Haruna Sato
- Department of Clinical Laboratories, Aomori Kyoritsu Hospital, Aomori, Japan
| | - Maki Soma
- Department of Clinical Laboratories, Aomori Kyoritsu Hospital, Aomori, Japan
| | - Emiko Okamura
- Department of Clinical Laboratories, Aomori Kyoritsu Hospital, Aomori, Japan
| | - Takashi Harada
- Department of Cardiology, Kitakyushu Municipal Yahata City Hospital, Kitakyushu, Japan
| | - Fuminobu Yoshimachi
- Department of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan
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Ross J, Vidovich MI. Relative importance of attribute preferences for radial vs. femoral arterial access: A crowdsourcing study of healthy online-recruited volunteers. Catheter Cardiovasc Interv 2018; 93:1237-1243. [PMID: 30341974 DOI: 10.1002/ccd.27941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is typically performed with vascular access provided by the radial or femoral artery. However, little is known about how patients value aspects of these different vascular access approaches. METHODS Conjoint analysis is a survey-based statistical technique used in market research that helps determine how individuals value different attributes that make up a particular product or services. We utilized conjoint analysis to assess the relative importance of four attributes associated with PCI: access site, risk of bleeding, hospital stay, and radiation exposure. Participants were healthy individuals recruited by Amazon Mechanical Turk (MTURK). After completing a conjoint analysis survey, the software Conjoint.ly was used to calculate the relative importance for these four different attributes of PCI. RESULTS The relative importance of hospital stay, radiation exposure, bleeding risk, and procedure site was 32.7% (95% CI 29.5-35.8), 27.3% (95% CI 24.8-29.8), 24.4% (95% CI 22.3-26.5), and 15.7% (95% CI 13.6-17.8), respectively. The difference between these groups was statistically significant (P-value < 0.00001). The difference between duration of hospital stay and radiation exposure was statistically significant (P-value < 0.00433). CONCLUSION Patients undergoing PCI place largest relative value on duration of hospital stay. Access site appears the least valued attribute. These findings carry implications to guide further research on access site choices and the consent process in the context of shared decision-making.
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Affiliation(s)
- Jason Ross
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Mladen I Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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Cauley R, Wu WW, Doval A, Chaikof E, Ho KKL, Iorio ML. Identifying Complications and Optimizing Consultations following Transradial Arterial Access for Cardiac Procedures. Ann Vasc Surg 2018; 56:87-96. [PMID: 30342206 DOI: 10.1016/j.avsg.2018.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The radial approach to cardiac procedures has become increasingly common. Although previous studies have suggested a favorable risk profile, serious complications can occur. The purpose of this study is to examine the incidence, subsequent treatment, and outcome of all suspected significant neurovascular complications following transradial cardiac procedures at a large US hospital. METHODS We reviewed all patients who underwent a left heart catheterization, coronary angiogram, or percutaneous coronary intervention via the transradial approach at a single large academic medical center in the United States between 2010 and 2016. Consultations to the vascular and hand surgery services were examined to assess demographic variables, risk factors, presenting symptoms, subsequent treatment, and outcome of all serious complications. RESULTS A total of 9,681 radial access cardiac procedures were performed during the study period. Twenty-four cases (0.25%) were suspected to have major complications and subsequently received consults. A total of 18 complications were diagnosed, including 8 vascular injuries or perforations, 4 hematomas, 4 radial artery occlusions, 1 case of compartment syndrome, and 1 severe radial artery spasm. Of the complications noted, 3 (16.7%) required operative interventions, but all recovered neurovascular function. CONCLUSIONS Radial artery access for cardiac procedures has become increasingly common and has been associated with a low rate of major peripheral neurovascular complications. The majority (83.3%) of complications were successfully treated with a nonoperative management algorithm.
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Affiliation(s)
- Ryan Cauley
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Winona W Wu
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andres Doval
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elliot Chaikof
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kalon K L Ho
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO.
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11
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Ramírez Vélez A, Gaviria Valencia S, Jaramillo Gómez N, Contreras Martínez H, Cardona Vélez J. Accesos vasculares femoral y radial en intervenciones coronarias percutáneas en síndrome coronario agudo y enfermedad crónica inestabilizada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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12
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Reich R, Rabelo-Silva ER, Santos SMD, Almeida MDA. Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. Rev Gaucha Enferm 2018; 38:e68716. [PMID: 29933427 DOI: 10.1590/1983-1447.2017.04.68716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.
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Affiliation(s)
- Rejane Reich
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Simone Marques Dos Santos
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Miriam de Abreu Almeida
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
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13
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Tröbs M, Achenbach S, Plank PM, Marwan M, Röther J, Klinghammer L, Blachutzik F, Schlundt C. Predictors of Technical Failure in Transradial Coronary Angiography and Intervention. Am J Cardiol 2017; 120:1508-1513. [PMID: 28844520 DOI: 10.1016/j.amjcard.2017.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/31/2023]
Abstract
Transradial access for coronary angiography and intervention is preferred over the femoral approach but can be technically challenging. Identification of predictors of transradial access failure is important, especially in the context of acute coronary syndromes. We therefore retrospectively analyzed 13,095 consecutive patients (66 ± 12 years, 64% male) in whom transradial access was attempted for coronary angiography or intervention to identify predictors of transradial access failure. Angiograms and patient files were systematically reviewed to analyze patient characteristics associated with failure. Transradial access failure rate was 6.8% (909 of 13,095). Patients with transradial access failure were more frequently female (9.5% vs 5.5%; p <0.001), significantly older (68 ± 12 vs 66 ± 12 years, p <0.001), and had a smaller body surface area (1.89 ± 0.21 vs 1.94 ± 0.2 m2; p <0.001). Transradial failure was not significantly more frequent in ST-elevation myocardial infarction versus other patients (8.1% vs 6.9%, p = 0.195). After multivariable adjustment, only female sex (odds ratio [OR] 1.44, p <0.001), higher patient age (OR 1.01/year, p = 0.002), and lower height (OR 0.98/cm, p = 0.004) independently predicted transradial access failure. In conclusion, female sex, higher age, and smaller height independently predict transradial access failure in coronary angiography and intervention. Failure rate in ST-elevation myocardial infarction is not significantly increased.
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14
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Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry. Aging Clin Exp Res 2017; 29:885-893. [PMID: 27832467 PMCID: PMC5590486 DOI: 10.1007/s40520-016-0649-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022]
Abstract
Background Katowice–Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES). Methods The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up. Results Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49–4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19–0.82); p = 0.012] in the elderly. Conclusion This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
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15
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Tsurumaki Y, Haraguchi Y, Nakamura T. Safety of Radial Access for Primary Percutaneous Intervention in Patients With ST-Elevation Acute Myocardial Infarction: Results From a Low-Volume Center. Angiology 2017; 69:387-392. [PMID: 28737069 DOI: 10.1177/0003319717722282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radial access for primary percutaneous coronary intervention (pPCI) in patients with ST-elevation acute myocardial infarction (STEMI) is recommended in high-volume experienced centers. This study investigated whether radial access for pPCI is safe even in a low-volume center. We performed radial access for pPCI in 171 patients. Major adverse cardiac events (total death, myocardial infarction, stroke) rate was 1.2%. The overall incidence of bleeding complications was 2.4%; there was no vascular complication at the access site. In patients with STEMI undergoing pPCI, the results of radial access in a low-volume center were acceptable. These findings support the safety of radial access in patients with STEMI.
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Affiliation(s)
- Yoshimasa Tsurumaki
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
| | - Yumiko Haraguchi
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
| | - Tomohiro Nakamura
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
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17
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Brener MI, Bush A, Miller JM, Hasan RK. Influence of radial versus femoral access site on coronary angiography and intervention outcomes: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 90:1093-1104. [DOI: 10.1002/ccd.27043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | - Aaron Bush
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Julie M. Miller
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Rani K. Hasan
- Johns Hopkins University School of Medicine; Baltimore Maryland
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18
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Pareek M, Bhatt DL, Ten Berg JM, Kristensen SD, Grove EL. Antithrombotic strategies for preventing long-term major adverse cardiovascular events in patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention. Expert Opin Pharmacother 2017; 18:875-883. [DOI: 10.1080/14656566.2017.1329822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Manan Pareek
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
- Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Jürrien M. Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Steen D. Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Erik L. Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Bivalirudin versus Heparin plus Glycoprotein IIb/IIIa Inhibitors in Women Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2017; 12:e0169951. [PMID: 28095453 PMCID: PMC5241007 DOI: 10.1371/journal.pone.0169951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022] Open
Abstract
Bivalirudin has been shown to be safe and efficacious compared with heparin plus glycoprotein IIb/IIIa inhibitor (GPI) in patients undergoing percutaneous coronary intervention (PCI). Whether bivalirudin would have the beneficial effects in female patients undergoing PCI remains unknown. We searched the literature for randomized controlled trials that assessed bivalirudin versus heparin plus GPI therapy in female patients undergoing PCI. The primary efficacy end point was major adverse cardiovascular events (MACE) within 30 days. The secondary efficacy end points were 30-day incidence of all-cause mortality, myocardial infarction (MI), urgent/ischemia-driven revascularization of target vessel. The safety end point was major bleeding up to 30 days. A total of 4,501 female patients were included in five randomized trials. No significant difference in MACE emerged between bivalirudin and heparin plus GPI at 30 days (8.15% vs 8.76%, RR 0.94, 95% CI 0.77-1.16, P = .57). There were no significant differences in rates of mortality (1.28% vs 1.91%, RR 0.74, 95% CI 0.45-1.20, P = .22), MI (5.46% vs 5.25%, RR 1.02, 95% CI 0.79-1.32, p = .88), or target vessel revascularization (2.13% vs 1.65%, RR 1.43, 95% CI 0.88-2.30, P = .15). Compared with heparin plus GPI, bivalirudin was associated with a significant reduction in 30-day major bleeding (5.32% vs 9.20%, RR 0.58, 95% CI 0.47-0.72, P < .0001). In conclusion, bivalirudin is associated with a significant reduction in 30-day major bleeding without increased ischemic events compared with heparin plus GPI in female patients undergoing PCI.
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Antiplatelet and Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Coronary Stenting. Interv Cardiol Clin 2016; 6:91-117. [PMID: 27886825 DOI: 10.1016/j.iccl.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stroke prevention is the main priority in the management cascade of atrial fibrillation. Most patients require long-term oral anticoagulation (OAC) and may require percutaneous coronary intervention. Prevention of recurrent cardiac ischemia and stent thrombosis necessitate dual antiplatelet therapy (DAPT) for up to 12 months. Triple antithrombotic therapy with OAC plus DAPT of shortest feasible duration is warranted, followed by dual antithrombotic therapy of OAC and antiplatelet agent, and OAC alone after 12 months. Because of elevated risk of hemorrhagic complications, new-generation drug-eluting stents, lower-intensity OAC, radial access, and routine use of gastric protection with proton pump inhibitors are recommended.
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Guide extension catheter stepwise advancement facilitated by repeated distal balloon anchoring. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:66-69. [PMID: 27638104 DOI: 10.1016/j.carrev.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
Coronary stent delivery can be extremely challenging in tortuous and calcified lesions especially when radial approach is chosen. Guide extension catheter is a useful tool for overcoming the inherent difficulties arising by the use of radial access in complex percutaneous interventions. We describe a technique for guide extension catheter system advancement by presenting two cases. This was performed stepwise by repeated distal balloon anchoring in the coronary artery of interest.
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22
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Andò G, Porto I, Montalescot G, Bolognese L, Trani C, Oreto G, Harrington RA, Bhatt DL. Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: Systematic review, collaborative meta-analysis, and meta-regression. Int J Cardiol 2016; 222:1031-1039. [PMID: 27537543 DOI: 10.1016/j.ijcard.2016.07.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/29/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients. METHODS We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients. Included studies had to meet the following criteria: 1) enrolling patients with NSTE-ACS undergoing invasive management; 2) reporting outcomes with respect to RA as compared with femoral access (FA); 3) reporting short-term (procedural, in-hospital and up to 30-day) or long-term clinical outcomes. Studies were pooled with fixed and random effects models and heterogeneity was investigated by weighted meta-regression. RESULTS Eleven studies were included encompassing 131.339 patients, 46.451 receiving RA and 84.888 receiving FA. Thirty-day mortality and MACE were lower with RA (p<0.001 with fixed effects, p=NS with random effects model), but these results depended on one large observational database. Major bleeding was consistently reduced by RA (p<0.001), albeit an inverse relationship with the proportion of patients in each study receiving FA and experiencing major bleeding was evident. The association of RA with reduced long-term mortality was of borderline significance (p=0.054 with random-effects, p=0.001 with fixed-effect model) and also depended on major bleeding in FA patients. CONCLUSIONS RA is associated with better outcomes as compared with FA in NSTE-ACS, although this observation is influenced by nonrandomized comparisons. Large heterogeneity exists among studies. REGISTRATION This study is registered in the PROSPERO database (CRD42015029459).
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Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gilles Montalescot
- ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre (AP-HP), Paris, France
| | - Leonardo Bolognese
- Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
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Voudris KV, Vidovich MI. Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage. J Transl Int Med 2016; 4:29-34. [PMID: 28191515 PMCID: PMC5290912 DOI: 10.1515/jtim-2016-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. METHODS From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. RESULTS The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. CONCLUSION Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.
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Affiliation(s)
- Konstantinos V. Voudris
- Department of Medicine, University of Illinois at Chicago / Advocate Christ Medical Centre, Chicago, IL 60612, USA
| | - Mladen I. Vidovich
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
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24
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Andò G, Porto I. Radial Access in Non-ST-Segment Elevation Acute Coronary Syndrome. Am J Cardiol 2016; 117:485-6. [PMID: 26704026 DOI: 10.1016/j.amjcard.2015.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
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